3 Ways to Fix Vertigo: Physiotherapy Treatment for Vertigo
Does rolling over in bed make the room spin?
Does looking up or down send you spinning?
It might be vertigo – and the good news is physiotherapy can help!
For Example, Ms. F. is a client whose recent visit to our physiotherapy clinic allowed her to return to work in just 10 days after being off for six weeks. Her dizziness prevented her from performing her duties as a nurse and she no longer was able to do any household chores. She reports stumbling when reaching under the sink for dish soap and nausea when turning over in bed. After her physiotherapy assessment, I prescribed the correct exercise that improved her sleep and she returned to household chores in just one visit.
What is Vertigo?
By definition, vertigo is the feeling of uncontrolled spinning. Feeling lightheaded or dizzy is different from spinning vertigo. Most often, vertigo is coming from your inner ear and is called Benign Paroxysmal Positional Vertigo (BPPV). Frequently, small crystals become dislodged in your inner ear, causing the inner ear to send incorrect information to the brain, creating vertigo.
Information sent to the brain from the ear with crystals does not jive with the information coming from the other ear, eyes or even the body’s joint position sense. When the brain receives this conflicting information, it produces nausea and vertigo.
Quick movements and movements that change the head position relative to gravity move the crystals more, creating more incorrect signals. This is why vertigo and nausea increase with bending, looking up, rolling and rapid movement.
The Top 3 Treatments for Vertigo
Treatment for vertigo is directly linked to the findings during an assessment. A physiotherapist will screen you for safety and mobility prior to completing the following treatments.
1. Epley’s Maneuver
The Dix-Hallpike maneuver is often performed during a physiotherapy assessment for dizziness. If you tried the Dix-Hallpike with a physiotherapist and felt spinning on one side, the Epley’s maneuver may be the right exercise to treat vertigo. If the right Dix-Hallpike was positive, the Epley's maneuver should begin with the head turned to the right.
The Epley Maneuver’s steps (right ear):
Start sitting on the bed with your head turned 45 degrees to the right. Place a pillow behind you so that it’s between your shoulder when you lay down.
Lie back quickly with your head still turned to the side and your head tipped back about 20 degrees from the pillow. Wait until all vertigo stops, then wait another minute.
Turn your head slowly 90 degrees to the left. Wait until all vertigo stops, plus another minute.
Roll your head another 90 degrees to the left so that you’re lying on your left side, looking down towards the floor. Wait for all vertigo to stop, plus another minute.
Sit up slowly from lying on the left side while looking over your shoulder.
Click Here to see a video demonstration
2. BBQ Roll
When spinning is felt with the Head Roll Test during a physiotherapy assessment, the BBQ Roll is often the treatment of choice for vertigo. When the left Head Roll test was positive, then the BBQ Roll is started with a small left turn, followed by a large right turn:
The BBQ Roll steps (left ear):
Start lying on your back with a pillow behind your head.
Roll onto your left side, making a 90 degree turn. Wait for any vertigo to stop.
Roll back onto your back, now looking up to the ceiling. Wait for any vertigo to stop.
Roll onto your right side, making another 90 degree turn. Wait for any vertigo to stop.
Roll to the right, onto your stomach, propping your fists under your chin to tip your head down. Wait for any vertigo to stop.
Still turning to your right, roll onto your left side. Once any vertigo has stopped, sit up from lying on your left.
Click Here to see a video demonstration
3. Semont Maneuver
The Semont Maneuver is an alternate to the Epley a physiotherapist may choose to recommend. It can be better tolerated for those with intolerance to the position or limitation in neck mobility or stroke risk. It takes diligence to maintain the correct head position and the speed of movement is important. To begin the Semont Maneuver in those diagnosed with right BPPV, the Semont Maneuver begins with the head turned to the left:
The Semont Maneuver (right ear)
Sit at the edge of a bed. Turn the head to the left 45 degrees.
Quickly lie on your right side, maintaining your left 45 degree head turn so that you are lying with your head tilted upward.
Wait one minute.
Keeping your head turned 45 degrees left, quickly sit up to the side of the bed and, without pausing, lay down on your left side with your face tilted downward.
Wait for one minute before returning to the seated position.
Click Here to see a video demonstration
Did All of Those Treatment Instructions Make the Room Spin?
Having a hard time figuring out which exercise to treat vertigo is right for you? Here’s where some 1-on-1 time with a qualified physiotherapist is key. Treatment techniques for BPPV vertigo are usually very successful, only needing 1 to 3 sessions. The trick is figuring out which vertigo exercise is right for you.
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FAQ
What causes vertigo?
Vertigo most often has an unknown cause (35% of incidents). However, it can also be caused by:
Head trauma (approximately 15%; ie. concussion or motor vehicle accident)
Meniere’s disease
Vestibular neuritis
Ear surgeries
What if my Dizziness is not BPPV?
A physiotherapy assessment will determine if BPPV is the cause of your dizziness/vertigo. If it is not, vestibular physiotherapy addresses many types of dizziness. Physiotherapists that practice vestibular physiotherapy can treat dizziness due to:
neck or jaw dysfunction
oculomotor dysfunction
cardiovascular concerns
concussion and brain injury
Often a physiotherapist may refer to other health care providers that, as a team, can work on your symptoms with you.
